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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Dried blood spot sampling as an alternative for the improvement of hepatitis B and C diagnosis in key populations
Geane Lopes Flores, Jakeline Ribeiro Barbosa, Helena Medina Cruz, Juliana Custódio Miguel, Denise Vigo Potsch, José Henrique Pilotto, Danielle Malta Lima, Jeová Keny Baima Colares, Carlos Eduardo Brandão-Mello, Marcia Maria Amendola Pires, Jurema Corrêa da Mota, Francisco I Bastos, Lia Laura Lewis-Ximenez, Livia Melo Villar
Geane Lopes Flores, Helena Medina Cruz, Juliana Custódio Miguel, Lia Laura Lewis-Ximenez, Livia Melo Villar, Viral Hepatitis Laboratory, FIOCRUZ, Rio de Janeiro 21040360, Brazil
Jakeline Ribeiro Barbosa, Jeová Keny Baima Colares, Postgraduate Program in Pathology, Federal University of Ceará, Fortaleza 60020181, Ceara, Brazil
Denise Vigo Potsch, Clementino Fraga Filho Hospital, Federal University of Rio de Janeiro, Rio de Janeiro 21040360, Brazil
José Henrique Pilotto, Nova Iguaçu General Hospital, Nova Iguaçu 26041061, Brazil
José Henrique Pilotto, Molecular Immunology Laboratory, Oswaldo Cruz Institute, Rio de Janeiro 21040360, Brazil
Danielle Malta Lima, Postgraduate Program in Medical Sciences, University of Fortaleza, Fortaleza 60811905, Ceará, Brazil
Carlos Eduardo Brandão-Mello, Marcia Maria Amendola Pires, Escola de Medicina e Cirurgia, Gaffrée & Guinle University Hospital, Federal University of Rio de Janeiro State, Rio de Janeiro 20270901, Brazil
Jurema Corrêa da Mota, Francisco I Bastos, Institute of Communication and Information on Science and Technology in Health, FIOCRUZ, Rio de Janeiro 21040360, Brazil
Author contributions: Villar LM conceived the study; Villar LM and Flores GL designed the research and the study protocol; Potsch DV, Pilotto JH, Lima DM, Baima Colares JK, Brandão-Mello CE, Pires MMA and Lewis-Ximenez LL carried out the participants’ selection and recruitment; Cruz HM, Barbosa JR, Miguel JC and Flores GL performed laboratory assays; da Mota JC and Bastos FI performed the statistical analysis; Flores GL, Villar LM, Mota JC and Bastos FI performed the analysis and interpretation of the data; Flores GL and Villar LM drafted the manuscript; Flores GL, Mota JC, Bastos FI and Villar LM critically revised the manuscript for intellectual content; All authors read and approved the final manuscript.
Supported by National Council for Scientific and Technological Development (CNPq); and Foundation for Research Support of the State of Rio de Janeiro (FAPERJ).
Institutional review board statement: The study was reviewed and approved by FIOCRUZ Ethics Committee, CAAE No. 34055514.9.3010.5258 and No. 1.001.477.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Livia Melo Villar, PhD, Research Scientist, Viral Hepatitis Laboratory, FIOCRUZ, Avenida Brasil, 4365, Rio de Janeiro 21040360, Brazil.
liviafiocruz@gmail.com
Received: August 17, 2020
Peer-review started: August 17, 2020
First decision: October 21, 2020
Revised: November 24, 2020
Accepted: December 13, 2020
Article in press: December 13, 2020
Published online: April 27, 2021
Processing time: 242 Days and 3.3 Hours
BACKGROUND
To achieve the elimination of hepatitis B and C, there is an urgent need to develop alternative strategies to increase the access of diagnosis, particularly among key populations such as people living with human immunodeficiency virus (HIV), individuals with coagulopathies and chronic kidney disease (CKD) patients.
AIM
To evaluate the use of dried blood spot (DBS) in the detection of hepatitis B virus (HBV) and hepatitis C virus (HCV) markers.
METHODS
A total of 430 individuals comprised of people living with HIV, coagulopathies and CKD provided paired serum and DBS samples. HBsAg, anti-HBc and anti-HCV were tested in those samples using a commercial electrochemiluminescence. Demographic and selected behavioral variables were evaluated to assess possible association with HBV and HCV positivity.
RESULTS
Using DBS, HBsAg prevalence varied from 3.9% to 22.1%, anti-HBc rates varied from 25.5% to 45.6% and anti-HCV positivity ranged from 15.9% to 41.2% in key populations. Specificities of HBV and HCV tests using DBS varied from 88.9% to 100%. The HBsAg assay demonstrated the best performance in CKD and coagulopathy individuals and the anti-HCV test had a sensitivity and specificity of 100% in people living with HIV. Accuracy of HBV and HCV detection in DBS varied from 90.2% to 100%. In the CKD group, HBsAg positivity was associated with infrequent use of condoms, and anti-HBc positivity was associated with sharing nail cutters/razors/toothbrushes. Anti-HCV reactivity was positively associated with a history of transplantation and length of time using hemodialysis in both specimens. In people living with HIV, only the male gender was associated with anti-HBc positivity in serum and DBS.
CONCLUSION
DBS with electrochemiluminescence are useful tools for the diagnosis and prevalence studies of hepatitis B and C among key populations and may increase the opportunity to foster prevention and treatment.
Core Tip: Dried blood spot (DBS) samples may be an alternative to serum to increase access and timeliness in the diagnosis of hepatitis B and C in key populations such as people living with human immunodeficiency virus, coagulopathies and chronic kidney disease. We found high accuracy for hepatitis B virus and hepatitis C virus detection using DBS. It was possible to observe similar hepatitis prevalence, demographic and clinical data related to hepatitis positivity in DBS and serum. DBS along with electrochemiluminescence could be used for diagnosis and prevalence studies of hepatitis B virus and hepatitis C virus among hard-to-reach populations.
